Asbestos, Mesothelioma, and Lymphoma
Lymphoma is a broad category of cancers that attack the cells of the lymphatic system, specifically lymphocytes, the white blood cells that play important roles in the immune system and help fight off pathogens and disease. Non-Hodgkin lymphoma is the most common type and researchers are finding that it may be related to asbestos and to mesothelioma. Some studies show elevated rates of non-Hodgkin lymphoma in people who were exposed to asbestos. There have also been a handful of cases that suggest mesothelioma can lead to lymphoma because of how asbestos fibers interact with lymphocytes and travel through lymph fluid to circulate through the body.
What is Lymphoma?
Lymphoma is a type of cancer that affects the cells of the immune system. Lymphocytes are white blood cells that play a role in defending the body against pathogens, like bacteria and viruses. Lymphocytes circulate through the body via the fluid in the lymphatic system. There are two types of lymphocytes: B cells make antibodies in response to pathogens and T cells of various types kill pathogens or change how active other immune cells are.
There are several different types of lymphoma, but two main categories: Hodgkin and non-Hodgkin lymphoma. The former is often called Hodgkin disease and the latter is often just called lymphoma. Both types of cancer begin in lymph tissue, which can be in one of many different locations because lymph tissue is found throughout the body. Clinically, Hodgkin disease is distinct from non-Hodgkin lymphoma by the presence of cells called Reed-Sternberg cells, a specific type of B cell.
In practical terms for the patient and for determining the course of treatment, the differences are more varied. Non-Hodgkin lymphoma is much more common and there are many different types of this lymphoma. Hodgkin disease is more likely to progress in a predictable way from one area of lymph tissue to another, whereas non-Hodgkin lymphoma is less predictable and is often diagnosed in the later stages. Hodgkin lymphoma is much more treatable.
Asbestos and Lymphoma
While a connection between asbestos and mesothelioma has long been established, exposure to asbestos is now being found through research to be related to other types of cancer. Some studies have seen a connection, for instance, between asbestos and non-Hodgkin lymphoma. One study saw that men exposed to asbestos were more likely to have lymphomas that began in the gastrointestinal tract or in the oral cavity. But the evidence is mixed, with some studies seeing no connection between asbestos and lymphoma.
One study was conducted in the 1980s and reviewed the records of a few thousand men who worked in asbestos-heavy industries in the 1950s. The researchers concluded that more men died from non-Hodgkin lymphoma than would be expected based on averages in the general population. The researchers hypothesized that asbestos fibers may get circulated around the body through the lymphatic system, a possible explanation for how asbestos may cause lymphomas.
A Case of Mesothelioma and Lymphoma
Although not all researchers can agree on reviews of populations exposed to asbestos and the incidence of lymphoma, one interesting case study describes a man who was diagnosed with mesothelioma and lymphoma. He had worked around asbestos insulation for 30 years and was diagnosed after presenting with pleural effusion, a buildup of fluid in the pleural tissue around the lungs. He was ultimately diagnosed with pleural mesothelioma and a type of non-Hodgkin lymphoma called plasmacytoid lymphocytic non-Hodgkin lymphoma. The lymphoma tumor was found in the man’s bone marrow in his spine.
The researchers who studied this patient noted that a handful of similar cases had been seen. They guessed that the asbestos fibers infiltrated the pleura, causing mesothelioma, but also moved through the lymphatic system and the blood, where they caused damage in other tissues. The researchers found asbestos fibers in the man’s bone marrow where a tumor had developed, supporting their model for how the two types of cancer were related and developed in the same patient. The researchers also believe that asbestos may cause cancer of the lymphocytes by stimulating B cells.
Although the researchers describe how mesothelioma and non-Hodgkin lymphoma can be connected, they also note how rare it is. Only a few cases have ever been described, so the possibility of asbestos fibers that caused mesothelioma going on to cause lymphoma as well is real, but unlikely.
Another connection between mesothelioma and cancer of lymphocytes is also extremely rare. Mesothelioma is often categorized by cell type, with most malignancies affecting epithelial cells. Less common is mesothelioma with a majority of cells of the sarcomatoid type. Sarcomatoid cells include mesenchymal tissue, the tissue that makes up the lymphatic system as well as bones and cartilage.
Sarcomatoid mesothelioma is less common than epithelial, and it is also more aggressive. These types of cells tend to detach from each other more readily, causing the cancer to spread more quickly. A very rare subtype of sarcomatoid mesothelioma is lymphohistiocytoid mesothelioma. The tumor in this kind of mesothelioma contains a mixture of cells, including some lymphocytes.
Why lymphocytes are involved in these types of mesothelioma tumors is not understood. What doctors do know is that this type of cancer is rare and difficult to treat. It is aggressive and spreads readily throughout the body, quickly becoming metastatic. The prognosis for this kind of mesothelioma is not very good, and most patients live less than a year after the diagnosis.
Drugs for Lymphoma and Mesothelioma
A recent finding furthers the connection between these two cancers. A drug that has been pushed through the approval process for treating lymphoma may also treat mesothelioma. Brentuximab vedotin is the drug and it targets a certain protein that promotes tumor growth in some types of lymphoma. The researchers who developed the drug tested several mesothelioma tumor samples for the protein and found that some of them did have the protein targeted by the drug. Applying the drug to the tumors, they found that cell growth was slowed. This is a promising possibility for treating some mesothelioma patients.
Mesothelioma and asbestos are clearly linked. Exposure to the mineral causes mesothelioma in some people. The link between asbestos, mesothelioma, and lymphoma is less obvious, but is becoming clearer. While some studies have struggled to find a connection, most have seen more lymphomas in people who have been exposed to asbestos and even lymphoma in people already diagnosed with mesothelioma. The connection may help to aid treatments, though, as drugs for one cancer may help treat the other.
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